Is He Faking? The Use of Waddell Signs in Workers’ Compensation Cases

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You sustain a back injury due to heavy lifting at work. You do all the right things – you immediately report the accident to your supervisor, you seek prompt medical care, you supply your employer off work notes from your doctor, and you’re compliant with treatment. Eventually your adjuster sends you for an Independent Medical Exam (IME). Shortly after the IME you receive the letter from your adjuster indicating the IME physician opined you could return to work and no treatment is needed. The IME report states – “Patient’s complaints disproportionate with exam findings. Patient exhibited 4/5 Waddell signs.” So what does this mean? In short, the IME physician believes that you are malingering or exaggerating your symptoms

Waddell’s signs are a group of physical signs designed to detect non-organic components to lower back pain. A non-organic symptom is one that deviates from the usual presentation of a particular condition. There are 5 categories of Waddell tests –

  1. Tenderness test
  2. Stimulation tests
  3. Distraction/Straight Leg test
  4. Weakness/Sensory test
  5. Over-reaction test.

The presence of three or more of these signs suggests a non-organic component to lower back pain.

IME physicians are notorious for equating positive Waddell signs to symptom magnification and/or malingering for secondary financial gain. This is simply an incorrect conclusion. Dr. Waddell himself has outright rejected the use of Waddell’s test to identify malingerers and symptom magnification. Dr. Waddell recognized that psychological factors such as anxiety and depression due to chronic pain, contribute to back pain. The purpose of the Waddell test is to identify patients with low back pain who may require a more detailed psychological assessment; not to identify exaggerators.

Factors such as the patient’s anxiety and the examiners bias can also lead to skewed Waddell results. Furthermore, the reliability of Waddell signs has only been tested among North American and English patients. The American Medical Association has recognized that cultural differences may influence the outcome of Waddell signs; noting that individuals from traditional Asian and Hispanic cultures are more likely to view the physician as an authoritative figure and thus less likely to disagree with a physician out of respect for the physician’s experience and education. In turn, this may lead the patient to try and guess the desired reaction or desired answer of the examiner.

If you are faced with this situation, it is important that you hire an experienced attorney who understands the purpose of Waddell signs, understands the true meaning of positive Waddell findings and knows what questions to ask the IME physician during cross examination.

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